PKR Nolander's LPKR Recovery Thread

[Nolander]

Hi folks. I have been remiss in my update duties so apologies. I am now 9.5 weeks post-op. Everything was going fairly well but I have suddenly hit a speed bump in my recovery and I am pretty freaked out. For the past 3-4 weeks my PT and I have been watching a pod of swelling above my kneecap over the end of my quadriceps tendon. The rest of my knee reacts to ice and compression and swelling is abated but this "capsule" of inflammation will not go away. Having sent pictures to my doctor's PA through the portal they said to keep and eye on it and look for signs of infection (there are none). Finally this past week I sent updated photos and asked to be seen (the office is in Boston, I am in Maine, 2.5 hour drive). The surgeon finally chimed in and said though it was not an emergency, he feared there might be a failure of the arthrotomy. He said to keep the leg straight, cease all PT, and come in Monday to be seen, that I may need another procedure.

Needless to say I am pretty freaked out. Leading up to this, most of my trouble has been around that spot, pain from the tendon, tight swelling. It was always an irritated part of the incision and the last to heal. I was doing well in PT and was riding my bike again, in fact, I did a 2-hour gravel ride last Sunday, 36 miles and 2000 feet of vertical with no problem! My quad muscles were starting to come back fairly well. I still get a lot of inflammation from being on my feet but really no kickback from the ride.

I am still icing very regularly to keep inflammation in check. Attached are some pictures of the "blob". It's far more pronounced with the joint bent at 90 degrees. Anyhow just wanted to share and vent. Has anyone had an experience like this?

 

[sistersinhim]

Oh my, that does look concerning. Please let us know what your doctor says. We will be here for you.

 

[EalingGran]

Sorry to hear and see this. It does look odd and I have never heard anyone else describe quite this. Definitely needs checking out. Is it very tender or hot?

 

[mendogal]

Oh dear. Glad you got an appointment! Please do keep us posted.

 

[Nolander]

Sorry to hear and see this. It does look odd and I have never heard anyone else describe quite this. Definitely needs checking out. Is it very tender or hot?

Not particularly. It's just swollen. It's much more pronounced if I bend the knee. The first pic is straight leg.

 

[Layla]

Wondering if it could be a seroma? In reading, hematomas usually develop within days of surgery, but not so with seroma's which develop between two and four weeks after surgery and from what you shared it sounds like you noticed it around five weeks or so ago. Obviously your surgeon will need to diagnose as he's the medical professional.

The definition of a seroma is "a pocket of clear serous fluid that sometimes develops in the body after surgery. This fluid is composed of blood plasma that has seeped out of ruptured small blood vessels and inflammatory fluid produced by the injured and dying cells." which pretty much describes a bursa.

Please stay in touch and let us know what you hear. All the best, Nolander.
@Nolander

 

[Nolander]

Wondering if it could be a seroma? In reading, hematomas usually develop within days of surgery, but not so with seroma's which develop between two and four weeks after surgery and from what you shared it sounds like you noticed it around five weeks or so ago. Obviously your surgeon will need to diagnose as he's the medical professional.

The definition of a seroma is "a pocket of clear serous fluid that sometimes develops in the body after surgery. This fluid is composed of blood plasma that has seeped out of ruptured small blood vessels and inflammatory fluid produced by the injured and dying cells." which pretty much describes a bursa.

Please stay in touch and let us know what you hear. All the best, Nolander.
@Nolander

Seems likely.

 

[Nolander]

My surgeon is quite confident that the internal sutures on the joint capsule have failed which is what has caused all the inflammation. I am now awaiting a second surgery date to reclose the capsule. Following the surgery, my leg will be immobilized for 4 weeks then followed by two weeks of restricted flex to 45 degrees.

To say the least, I am quite bummed.

 

[sistersinhim]

No wonder you are bummed. I would be, too. How disappointing that you have to have more surgery. Does he know what caused these stitches to fail? I think it's a very good idea to immobilize your knee afterward to allow the much-needed healing to take place.

We are here for you!

 

[mendogal]

Dang, that's a hard pill to swallow; I'm sorry for this setback. Hopefully it will resolve the problem with a full recovery.

 

[Nolander]

No wonder you are bummed. I would be, too. How disappointing that you have to have more surgery. Does he know what caused these stitches to fail? I think it's a very good idea to immobilize your knee afterward to allow the much-needed healing to take place.

We are here for you!

They didn't speculate. I feel like I followed the post-op guidelines to a T. But for some reason, they did fail. He said he uses absorbable sutures but for this revision, he will not use those. The thing is I had pronounced pain in that spot even at 3 weeks-ish and pointed it out in my 4-week checkup but they did not think it was anything outside of normal. :(

 

[Layla]

Aww, Nolander, I am so sorry. That's a tough one. I hope they're able to address this soon so you can get back on the road to recovery. Please keep us in the loop, we're here for support always.
@Nolander

 

[Jamie]

This is certainly not something that happens frequently. So sorry you need more surgery. Please let us know how things go and if the surgeon has any more details about what has happened.

 

[Nolander]

Scheduled for Tuesday the 14th for the arthrotomy. I'll let y'all know how it goes.

 

[Layla]

Hi Nolander,
Your signature has been edited to reflect the procedure you'll undergo on Tuesday.
I wish you all the best and will look forward to your first update.
@Nolander

 

[sistersinhim]

Please do let us know what you find out on Tuesday.

 

[Layla]

Best of luck tomorrow. We will look forward to hearing from you soon.
@Nolander

 

[Nolander]

Ho folks. Just checking in. Yesterday went well. The internal sutures had indeed failed and were repaired with permanent sutures instead of absorbable this time. I have to keep the leg straight in a brace for two weeks at least followed by only 45 degree bend for a while. The pain is not too bad. They only prescribed Tylenol but luckily I had some leftover good stuff from the first surgery that came in handy last night as there was quite a bit of post-op pain.

So back to crappy sleep for a while, unfortunately:(

 

[mendogal]

(sigh) ... back indeed... I'm glad the diagnosis was correct and readily repaired. Hang in there... hopefully a smoother road from here.

 

[sistersinhim]

I know you are glad that surgery is over. Now, to get through your recovery without another incident!